Document Detail


Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in Asian patients with large artery occlusive disease: a randomised study.
MedLine Citation:
PMID:  17434095     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Acute stroke patients with large artery occlusive disease (LAOD) have a distinct pathophysiology and may respond differently to anticoagulation treatments. We compared the efficacy of a low-molecular-weight heparin (LMWH), nadroparin calcium, with aspirin in Asian acute stroke patients with LAOD.
METHODS: Acute ischaemic stroke patients with onset of symptoms less than 48 h and LAOD (diagnosed by transcranial doppler imaging, carotid duplex scan, or magnetic resonance angiography) were recruited. Patients were randomly assigned to receive either subcutaneous nadroparin calcium 3800 anti-factor Xa IU/0.4 mL twice daily or oral aspirin 160 mg daily for 10 days, and then all received aspirin 80-300 mg once daily for 6 months. This study is registered at www.strokecenter.org/trials (number 493).
FINDINGS: Among 603 patients recruited, 353 (180 LMWH, 173 aspirin) had LAOD (300 had intracranial LAOD only, 42 had both intracranial and extracranial disease, and 11 had extracranial disease only). The proportion of patients with good outcomes at 6 months (Barthel index >or=85) was 73% in the LMWH group and 69% in the aspirin group (absolute risk reduction 4%; 95% CI -5 to 13). Analysis of prespecified secondary outcome measures showed a benefit in outcome for LMWH versus aspirin on the modified Rankin scale dichotomised at 0-1 (odds ratio 1.55, 95% CI 1.02-2.35). Haemorrhagic transformation of infarct and severe adverse events were similar in both groups. Post-hoc analyses of patients without LAOD, and all treated patients, showed similar proportions with a good outcome in aspirin and LMWH groups (78%vs 79% and 73%vs 75%, respectively).
INTERPRETATION: Overall, the results do not support a significant benefit of LMWH over aspirin in patients with LAOD. The benefits indicated in most outcome measures warrant further investigation into the use of anticoagulation for acute stroke in patients with large artery atherosclerosis, particularly in intracranial atherosclerosis.
Authors:
Ka Sing Wong; Christopher Chen; Ping Wing Ng; Tak Hong Tsoi; Ho Lun Li; Wing Chi Fong; Jonas Yeung; Chi Keung Wong; Kin Keung Yip; Hong Gao; Hwee Bee Wong;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Lancet. Neurology     Volume:  6     ISSN:  1474-4422     ISO Abbreviation:  Lancet Neurol     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-16     Completed Date:  2007-05-08     Revised Date:  2014-08-15    
Medline Journal Info:
Nlm Unique ID:  101139309     Medline TA:  Lancet Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  407-13     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adult
Aged
Aged, 80 and over
Anticoagulants / administration & dosage,  adverse effects,  therapeutic use*
Arterial Occlusive Diseases / complications*
Asian Continental Ancestry Group*
Aspirin / administration & dosage,  adverse effects,  therapeutic use
Brain Ischemia / complications*,  ethnology
Female
Hemorrhage / chemically induced
Humans
Injections, Subcutaneous
Male
Middle Aged
Nadroparin / administration & dosage,  adverse effects,  therapeutic use*
Stroke / drug therapy*,  ethnology,  etiology
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Nadroparin; R16CO5Y76E/Aspirin
Comments/Corrections
Comment In:
Lancet Neurol. 2007 May;6(5):381-2   [PMID:  17434083 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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